Your doctor says to take a statin to lower your cholesterol. You’re not convinced.
High cholesterol levels have a direct impact on your risk of heart attack and stroke, so you don’t want to make a hasty decision. Make sure your concerns are valid before you reject a statin -- their benefits to your heart are noteworthy.
Can Exercise and Diet Lower Your Cholesterol Enough?
There’s no doubt that a healthy lifestyle helps lower cholesterol. The question is whether it can lower your levels enough – and that depends on how high your levels are and what your doctor has set as your goal.
- Eating a heart-healthy diet can lower LDL cholesterol at least 10%.
- If you lose 5% to 10% of your body weight, you can cut LDL cholesterol 15%, and reduce triglycerides 20%.
- If you exercise at a moderate intensity -- meaning you have enough breath to talk but not sing -- for at least 2 ½ hours a week, you can further cut triglycerides 20% to 30%. (Exercise can also increase your HDL, the “good” cholesterol.)
That’s a great start, says Michael Miller, MD, director of the Center for Preventive Cardiology at the University of Maryland Medical Center. "Lifestyle changes certainly are the cornerstone of cholesterol reduction."
To get your cholesterol down to lower your risk of cardiovascular disease your doctor may recommend, though, that you still need a statin. These powerful cholesterol-lowering medicines include atorvastatin (Lipitor), pravastatin (Pravachol), and simvastatin (Zocor), among others.
What a Statin Can Do
"Statins are very simple: You take them once a day, and their effects are quite profound," says Patrick McBride, MD, MPH, director of the cholesterol clinic at the University of Wisconsin School of Medicine and Public Health.
- Statins quickly reduce LDL, the "bad," cholesterol by 50% or more.
- Statins boost HDL, the "good" cholesterol, by up to 15%.
You should see major changes in your cholesterol levels within two to four weeks after starting treatment.
When you take a statin, you do more than improve your cholesterol levels. They also reduce your risk of heart attack, stroke, and other heart problems. “Statins are one of the great success stories of modern medicine," McBride says.
So does taking a statin mean you can sit on the couch and eat bacon all day? Of course not. Doctors say the best way to protect your heart is to make healthy lifestyle changes while taking a statin.
Potential Side Effects
Like any medicine, statins can interact with other medicines you take, and they can have side effects:
- More common: Headache, GI problems, muscle and joint aches, or rash
- Less common: Memory loss, mental confusion, high blood sugar, and type 2 diabetes
- Very rarely: Muscle or liver damage
Research shows that some people with muscle aches from statins feel better when they take extra CoQ10, a substance your body makes to help cells produce energy. Don’t take CoQ10 supplements on your own, however. Work with your doctor when you take any supplement.
Overall, the risks of taking statins are very low -- lower than the risks from taking two aspirin a day, McBride says. "The benefits are well-established, with hundreds of thousands of people studied in clinical trials.”
Some people take supplements along with statins, or -- if their cholesterol isn't too high -- instead of them. There's good evidence that some supplements can help with cholesterol levels.
- Fish oil can lower triglycerides by up to 50% and improve HDL levels, the “good” cholesterol. People in most studies showing a benefit have taken 1 to 4 grams of fish oil a day. While usually well-tolerated, fish oil supplements can cause a fishy aftertaste, heartburn, or upset stomach.
- Sterols and stanols are available in supplements and are also added to foods such as some margarines, orange juice, or yogurt. These can lower LDL, the “bad” cholesterol, by up to 15%. Cholesterol experts recommend 2 grams per day.
Soluble fiber -- available in supplements such as psyllium as well as in food -- can lower LDL cholesterol.. For every 5 to 10 grams that you add to your diet, you can lower your levels by up to 5%. Try to get at least 25 to 30 grams of total fiber a day. Most fruits, vegetables, and oats have both soluble and insoluble fiber.
Questions to Ask Your Doctor
If you’re not sure why your doctor prescribed statins to lower your cholesterol, ask at your next appointment.
- Why do you think I need a statin?
- What will it do for me?
- Based on my specific health, what might I gain from taking one and what are my risks?
- Could a statin interact with any medicines or supplements I’m taking?
- When will I know if this drug is working?
- Can I take a supplement instead of -- or along with -- a statin to lower my cholesterol?
- What supplements or treatments will ease side effects?
Miller tells his patients to look at statins like a daily vitamin to boost health. "In many ways, that’s what it is," he says, "and it’s the only one that we know that works so well to improve cholesterol and lower cardiovascular risk."